Town of Winthrop : Record of Deaths 1951, Part 85

Author: Winthrop (Mass.)
Publication date: 1951
Publisher:
Number of Pages: 614


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 85


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death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar may require. -- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupatibn, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.


Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


R-302 1


PLACE OF DEATH


Middlesex (County) Arlington


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF


CERTIFICATE OF DEATH


Arlington


(City or town making return)


Registered No.


464 237


(City or Town) Abbott's Convalescent Home No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME


15 Park Circle George .... A. Myers


(If deceased is a married, widowed or divorced woman, give also maiden name.)


359 Shirley Street


St.


Winthrop


Mass.


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death.


.years.


months.


23


days. In place of residenceLO


.years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


October


30


1951


(Month)


(Day)


(Year)


8 SEX


Male


9 COLOR OR RACE


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


4 I HEREBY CERTIFY,


Oct. 20


51


19


to


Oct. 30


19 ..


51


I last saw


h


im


alive on


Oct.


30


.... 19 57 death is said to


have occurred on the date stated above, at.


4:30P


.m.


INTERVAL BE-


(Husband's name in full)


DISEASE OR CONDITION DIRECTLY LEADING


TO DEATH


(a).


Carcinoma of


the lung


ANTE Due To CEDENT (b) CAUSES


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


Carcinoma of lung


Date of operation Sept .... 1951was autopsy performed?


No


What test confirmed diagnosis ?.


Biopsy ..


5 Was disease or injury in any way related to occupation of deceased ?. NO.


If so, specify,


(Signed)


Tilliam A. Dawa, Jr.


M.D.


(Address) Arlington Mass, Date 10-30- 1951


Roxbury Mutual Cem -Montvale 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL.


November


1


1951


7 NAME OF


FUNERAL DIRECTORBenjamin F. Solomon


ADDRESS


420 Harvard St., Brookline


Received and filed 19


NOV & 1951


(Registrar of City or Town where deceased resided)


11 IF STILLBORN, enter that fact here.


12


69


AGE


Years


Months


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation:


Cigar Maker


(Kind of work done during most of working life)


14 Industry


or Business:


Cigar


15 Social Security No.


032-03-3906


16 BIRTHPLACE (City).


(State or country)


England


17 NAME OF


FATHER


Wolf. Myers


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Esther Durand


20 BIRTHPLACE OF


MOTHER (City)


-


(State or country)


England


21 William Myers


Informant


(Address)


36 Forrest Sto, Winthrop


A TRUE COPY


ATTEST:


Registrar of City of Town where death occurred)


DATE FILED


October


31


19


51


10a If married, widowed, or divorced


HUSBAND of.


Sadie Moscow


(Give maiden name of wife in full)


(or) WIFE of


TWEEN ONSET AND DEATH 1 yr


50m-(e)-10-48-24658


after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


(Was deceased a


U. S. War Veteran,


No


{ if so specify WAR)


(write the word)


That I attended deceased from


١٠


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)


25M (E )-6.50.902253


PLACE OF DEATH


Essex (County)


Danvers


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danw.r.s


(City or town making return)


238


f(If death occurred in a hospital or institution, No. Danvers ... State ..... Hospital, ... Hathorne


2 FULL NAME. Charles Rogers


(If deceased is a married, widowed or divorced woman, give also maiden name.)


63 Fremont


St.


Winthrop


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years ..


1months 5


days. In place of residence.


... years.


months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


October


20,


19.5.1


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Sept .15, 19 51


to


Oct. 20


19


51


I last saw h


im alive on


Oct. 20


19.51


death is said to


10a If married, widowed, or divorced,


HUSBAND of


Unknown


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


Years.


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation:


Attorney


( Retired )


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No ..


Unknown


16 BIRTHPLACE (City)


(State or country)


Mass.


Chelsea


17 NAME OF


FATHER


Charles Richard Roger


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass


19 MAIDEN NAME


OF MOTHER


Grace Alice Wilkins


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass.


Boston


21 Mary E. Sheehan


Informant.


(Address)


Hathorne, Mass.


A TRUE COPY


ATTEST:


(Registrar of City or Town where death osgurred)


October


30,


51


(Registrar of City or Town where deceased resided)


8 SEX


Male


9 COLOR OR RACE


White


MARRIED


WIDOWED


or DIVORCED id owed


have occurred on the date stated above, at.


9:30 a.m.


INTERVAL BE-


DISEASE OR CONDITION DIRECTLY LEADIN TO DEATH (a)


Generalized Arterio-


sclerosis


years


ANTE CEDENT (b) CAUSES


Due To


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


Date of operation


Was autopsy performed ?.


No


What test confirmed diagnosis?


Lab. & Clinical


5 Was disease or injury in any way related to occupation of deceased? if so, specifyAndrew Nichols 3rd. (Signed) Danvers, Mass.


(Address)


WinthropCemetery 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


October


23. ...... 1951


7 NAME OF


FUNERAL DIRECTOR


Howard S .Reynolds


Winthrop, Mass.


ADDRESS


Received and filed NOV 1 5 1951 19


DATE FILED


19


R-302 1


Registered No.


St. [ give its NAME instead of street and number) - (Was deceased a U. S. War Veteran, if so specify WAR)


10 SINGLE


(write the word)


(Give maiden name of wife in full)


TWEEN ONSET


AND DEATH


73


Boston


PARENTS


Date


10/30/M.59-


Winthrop


R-302 1


PLACE OF DEATH


...


Suffolk (County)


Revere


(City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Revere


(City or town making return)


Registered No.


239


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME.


Ester A. Madison (Hull)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. 130 Grovers Avenue


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


3


a.s.


years.


months.


days. In place of residence


years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


October


21


1951


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I_ attended deceased


from


Jan, 10


49


October 21


51


19


to


19


I last saw h


er.alive on


October 211,51


death is said to


3:35 A .m.


have occurred on the date stated above, at.


INTERVAL BE-


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary-occlusion acute


TWEEN ONSET ANO DEATH 1 day


11 IF STILLBORN. enter that fact here.


80


12


AGE


Years


Months.


Days


If under 24 hours


.Hours .......


Minutes


ANTE


Due To


Arteriosclerotic


CEDENT (b)


CAUSES feart Dis.


Due To


General arterio-


(c)


sclerosis


3 years


OTHER


SIGNIFICANT


CONDITIONS


None


Major findings:


Of operations.


None


Date of operation.


Was autopsy performed? No


What test confirmed diagnosis ?.


None


No


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


Myron N. King


MOP


(Address)


Deep River 6 Place of Burial or Cremation October 23


DATE OF BURIAL.


Maurice/Kirby


ADDRESS


Received and filed NOV 14 1951


PARENTS


18 BIRTHPLACE OFDeep River FATHER (City) (State or country) Conn.


19 MAIDEN NAME OF MOTHER Unknown


20 BIRTHPLACE OFDeep River


MOTHER (City)


(State or country)


Conn.


21 Rufus Madison


Informant (Address) Winthrop Arms Hotel


A TRUE COPY.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


October 30,


.19.51


(Registrar of City or Town where deceased resided)


8 SEX


Female


9 COLOR OR RACE


White-


10 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


Miles Madison


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


Housewife


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No.


16 BIRTHPLACE (City).NewYork (State or country)


17 NAME OF


FATHER


Therba Hull


Conn.


(City or Town)


51


19


7 NAME OF


FUNERAL DIRECTOR


Winthrop


St.


10/21


195


Date


3 years


50m-(e)-10-48-24658


after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


(Usual place of abode)


36


Winthrop


(Was deceased a


U. S. War Veteran,


if so specify WAR)


No.


Resthaven


R-302 1


PLACE OF DEATH


SUFFOLK BOSTON


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


9348


Registered No.


210


Mags. General Hospital No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


Elizabeth Kinnear


(If deceased is a married, widowed or divorced woman, give also maiden name.)


107 Ba doin St


St.


Winthrop Mass.


(a) Residence. No. (Usual place of abode)


25


(If nonresident, give city or town and State)


Length of stay: In place of death


........


.years.


.. months.


10


.days. In place of residence


years.


months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Oct.22/51


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


Oct. 11 19 51


to


That


I attended deceased


from


Oct. 22


51


19


I last saw }


eralive on


19.


death is said to


12;47P


.m.


INTERVAL BE-


10a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


Samuel L Kinnear


(or) WIFE of.


(Husband's name in full)


DISEASE OR CONDITION DIRECTLY LEADING


TO DEATH (a)


Nephrosclerosis


3 Yr


Plus


72


12


AGE


Years


0


27


Months


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation:


At Home


18 Yr


Plus


(Kind of work done during most of working life)


14 Industry or Business:


S15 Social Security No ..


None


16 BIRTHPLACE (City)


(State or country)


England.


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


None


Date of operation


.Was autopsy performed?


Yes


What test confirmed diagnosis?


autopsy


5 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


CL Clay


M. D


(Address)


Mass General Hoopt


10-225 51


WinthropCem-Winthrop Mass


6


Place of Burial or Cremation


Oct. 25/51


19


21


Informant.


(Address)


S Kinnear


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


Received and filed. 19


NOV 1 3 1951


(Registrar of City of Town where deceased resided)


PARENTS


18 BIRTHPLACE OF


FATHER (City).


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Martha Rogers


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


A B Marsh


ADDRESS Winthrop Mass.


8 SEX


F


9 COLOR OR RACE


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


have occurred on the date stated above. at


TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


ANTE


CEDENT (b)


Due To


Diabetes mellitus


Due To


Atrophy of the pancreas


(c)


18 Y P189


Oct. 22


51


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES 25M (E)-6.50.902253


2 FULL NAME


(Was deceased a


U. S. War Veteran,


if so specify WAR)


DATE FILED Oct. 25/51


19


17 NAME OF


FATHER


Samuel Cook


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)


25M (E )-6.50.902253


PLACE OF DEATHE


DECLINED JURISDICTION SUFFOLK BOSTON


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No.


9.3.8.8.


241


¡(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)


2 FULL NAME. Samuel ... Simons


(If deceased is a married, widowed or divorced woman, give also maiden name.)


12 Nevada St


St


Winthrop Mass


(If nonresident, give city or town and State)


Length of stay: In place of death ..... ... years ... .months. .days. In place of residence .L.Q. .years months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


October 24, 1951


(Month)


(Day)


(Year)


8 SEX


Male


9 COLOR OR RACE


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


4 I HEREBY CERTIFY,


That I attended deceased from


Oct.24


19


.5.1,


to


Oct 24


19 ... 5.1


I last saw }


alive on


19


death is said to


have occurred on the date stated above, at 12:45 pm.


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12


AGE


7.1.Years


Months.


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation:


Fruit dealer


(Kind of work done during most of working life)


14 Industry


or Business:


Retired


15 Social Security No.


16 BIRTHPLACE (City).


(State or country)


Russia


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations ..


Date of operation


Was autopsy performed ?..


....... n.o.


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased? If so, specify ..


(Signed)


I H Park


(Address) Brookline Mass


Date Oct 24


19.51


6 Everett Beth Israel Cem


Place of Burial or Cremation


Everett Mass


(City or Town)


DATE OF BURIAL


Oct ... 25


1952


21


Informant


(Address)


Wife


7 NAME OF


FUNERAL DIRECTOR


B Birnbach


ADDRESS Boston Mass


Received and filed.


NOV 1 3 1951


19


(Registrar of City or Town where deceased resided)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


Sylvia


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


A TRUE COPY


ATTEST:


happen 21 IMAL


C


(Registrar of City or Town where death occurred)


DATE FILED


Oct ... 2.9.


19.


51


4


ANTE


Due To


CEDENT (b)


CAUSES


Arteriosclerotic


heart disease


Due To


Generalized.arterio


(c)


sclerosis


10a If married, widowed, or divorced


HUSBAND of.


Mary Smokler


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Acute ..... coronary


thrombosis


abt


10 mins


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No. (Usual place of abode)


No.


Anne Starr Nursing Home


R-302 1


17 NAME OF FATHER Aaron Simons


+


PLACE OF DEATH


Suffolk (County)


Bos ton


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


Boston


(City or town making return) 9652


Registered No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME


Roderick Murray


(If deceased is a married, widowed or divorced woman, give also maiden name.)


31 Revere


Winthrop Mass.


St.


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death. .. years months. 1


days. In place of residence ... ].Q ... years.


.. months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR OR RACE


10 SINGLE


write the word)


MARRIED


WIDOWED


or DIVORCED


Married


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


Oct. 31


19


51


to.


Nov. 1


51


19


death is said to


have occurred on the date stated above, at


8;OLA


m.


INTERVAL BE-


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


Years


44


3


22


Months


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Fisherman


(Kind of work done during most of working life)


14 Industry


or Business:


Fish


15 Social Security No ..


022-18-4214


16 BIRTHPLACE (City)


(State or country)


Newfoundland


17 NAME OF


FATHER


John W Murray


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Newfoundland N.S.


Date of operation.


None


Was autopsy performed?


No


What test confirmed diagnosis?


clinical


5 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


L Lezer


Mass. General Hospital 11-1


(Address)


Winthrop Cem-Winthrop Lass,


6 Place of Burial or Cremati Nov.5/51 (City or Town)


DATE OF BURIAL 19


7 NAME OF


FUNERAL DIRECTOR


E P Caggiano


ADDRESS Winthrop Mass.


Received and filed. 19


NOV 1 3 1951


(Registrar of City or Town where deceased resided)


PARENTS


19 MAIDEN NAME


OF MOTHER


Annastasia Tucker


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Newfoundland N.S.


Mrs Mary Murray


21


Informant


(Address)


A TRUE COPY


Charge of InaCA


(Registrar of City or Town where death occurred)


DATE FILED


Nov. 5/51


........ 19


10a If married, widowed, or divorced


Mary J Whiffen


HUSBAND of


(Give maiden name of wife in full)


DISEASE OR CONDITION


DIRECTLY LEADING


Myocardial infarction


TWEEN ONSET AND DEATH 15 Hr


TO DEATH (a)


Due To


Arterio sclerotic


disease


Due To (c)


OTHER


SIGNIFICANT


Obstructive vascular


disease .... legs


3} Yrs


3 DATE OF


DEATH


ANTE


CEDENT (b)


CAUSES


Major findings:


Of operations


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible


CONDITIONS


25M (E)-6.50.902253


R-302 1


CERTIFICATE OF DEATH


Mass. General Hospital


No.


Nov. 1/51


That


I attended deceased from


Nov. 1


19


51


I last saw h ... im ... alive on


heart


6 Mos


(or) WIFE of


(Was deceased a


U. S. War Veteran,


( if so specify WAR)


R-301A 1


PLACE OF DEATH


Suffolk


(County) Winthrop


(City or Town) 1 Sea Foam,


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD VIETE CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


243


are


f(If, death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Morris Janeller


(If deceased is a married, widowed or divorced woman, give also maiden name.)


25 Granates


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death years.


/ ... months.


days. In place of residence


40 years


.months. .days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


November


(Month)


(Day)


1951 (Year)


4 I HEREBY CERTIFY,


19


... to 19 ....


I last saw h ............. alive on


19 .---- , death is said to


have occurred on the date stated above, at. 9 A. m.


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Natural causes


ANTE CEDENT (b) CAUSES


Due To


arteno-sclerotic


Heart Disease


Due To


(c)


OTHER SIGNIFICANT CONDITIONS


Major findings:


Of operations.


Date of operation


Was autopsy performed? no


What test confirmed diagnosis?


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12 AGE . Years


.. Months ... .Days


If under 24 hours .Hours Minutes


13 Usual Occupation:


Junk Dealer


14 Industry or Business!


(Kind of work done during most of working life) For Herical


15 Social Security No ...


16 BIRTHPLACE (City) (State or country)


17 NAME OF FATHER Mah Suneller


18 BIRTHPLACE OF FATHER (City) (State or country)


19 MAIDEN NAME OF MOTHER Jaky Learell


20 BIRTHPLACE OF MOTHER (City) (State or country)


La


Laveller


21 Informant SS 25 Brooks St. E Busco


7 NAME OF FUNERAL DIRECTOR Benjamin Simback


ADDR 10 Washington St Manchester 19


Received and filed ..


NOV 6 1951


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR ÓR RACE What


10 SINGLE MARRIED WIDOWED or DIVORCED Feed


(write the word)


If n HUSBAND of ...


d, or divorced lickson


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


63


PARENTS


5 Was disease or injury in my way related to ochpation of deceased? no


it Canthin C. Man


(Signed))


ess Minthaoch Boand Healthy


M. D.


o levere Com.


Place of Bunal or Cremation


cereal (City or Town)


50M (B)-1.51 903586


JCTIONS OR CERTIFICATE iving F DEATH t enter han one or each ) and (c)


Des not mean dying, such re, asthenia, s the disease, tions which ·


conditions. g rise to the (a) stating ing cause


ns contrib- eath but not disease or using death.




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